Interim
Joint Committee on Banking and Insurance

Minutes
of the<MeetNo1>1st Meeting

of
the 2013 Interim

<MeetMDY1>June 25, 2013

Call to Order and Roll Call

The<MeetNo2>1st meeting of the Interim Joint
Committee on Banking and Insurance was held on<Day>Tuesday,<MeetMDY2>June
25, 2013, at<MeetTime>10:00 AM, in<Room>Room 149 of the Capitol Annex. Representative
Jeff Greer, Chair, called the meeting to order, and the secretary called the
roll.

Dr. Shelli Deskins, Director, Highlands Center for Autism, discussed
the center’s program. The center treats 10 children, ages 2-15. There are 13 staff
members who provide 30-32.5 hours of applied behavioral analysis (ABA). They also
provide parent training, home visits, and interaction with parents at the
center. Dr. Deskins stated that there has been much success and shared a video on
the progress of a child over a 2 year treatment period. The video showed the child
who initially was non-verbal but who later spoke her first words and was able
to carry out daily tasks. Reimbursement remains a challenge, despite the
mandate passed in 2010 House Bill 159. Many times the insurance companies will
not reimburse parents, who then must pay the bills themselves.

Representative Steve Riggs stated that there is more work needed
to help autistic children.

Representative Jeff Greer stated that he is making a
personal pledge to work on streamlining the process between claimants, centers
and insurance companies.

Senator Carroll asked about the severity of autism of the
girl in the video and whether Dr. Deskins had contacted the Department of
Insurance. Dr. Deskins stated that the young girl in the video is severely
autistic. Children at the center range from moderate to severely impaired. The
center has worked very hard with insurance companies and has filed complaints
with the Department of Insurance.

Senator Girdler stated that he has visited the Highlands
Center for Autism and encourages members to tour the facility. He applauds the staff’s
outstanding work.

Senator Buford asked whether the center accepts Medicaid. Dr.
Deskins stated that the center is not a Medicaid provider.

Senator Carroll asked whether the Center has contacted the
Department of Education to see if it has access to methods of treating children
with autism. Dr. Deskins stated that she had not contacted the department.

Representative Steve Riggs asked how the “Affordable Care
Act” affects the center. Dr. Deskins said that remains to be seen.

Greg Wilson and Tyler Hall parents of children who attend
the center discussed how ABA treatment at the center has changed and improved
their children and families’ lives. They said that the increase in speaking,
vocabulary, and learning of daily living skills has been amazing and life
changing. The financial struggles have been very hard, but they know they must
provide ABA treatment for their children for them to be functioning members of
society. They have filed numerous claims for reimbursement with their insurance
companies in accordance with House Bill 159 and have received little or no
money. Dr. Deskins stated that the struggle with reimbursement is typical of
the families at the center.

Lorri Unumb, Vice President of State Government Affairs,
Autism Speaks, stated that House Bill 159 has been used as model legislation
across the United States. Thirty-three states have laws regarding reimbursement
for treatment of autism. She has written a book entitled “Autism and the Law.”

There are several issues hindering ABA treatment:

1)Denial.

ABA
is sometimes coded as educational instead healthcare. This is not appropriate
because the underlying condition is a medical condition and must be paid.

2)Service not medically necessary.

She
stated that ABA treatment is legitimate and is prescribed by a physician.

3)Supervision of treatment.

She stated that there
is planning, oversight, and monitoring of the treatment. Many times the
treatment is implemented by others.

4)Billing codes.

She stated that
billing codes are a problem with insurance companies. The problem is being
addressed with the American Medical Association. It would possibly help if the
Department of Insurance issued a bulletin regarding the acceptable codes to be
used by insurance companies.

5)Providers not willing to be in-network.

She stated that this presents
problems for families and providers.

Representative Jim Gooch asked if the Highlands Center was
in-network. Dr. Deskins stated that it is not in-network.

Senator Tom Buford asked
how the “Affordable Care Act” applies to ABA treatment. Lorri Unumb stated the
health care reform prohibits monetary caps, and Kentucky has a $10,000 annual
cap for small group members with autism spectrum disorder and $50,000 annual
cap for large groups. Senator Buford stated that there may be a need to amend
the Kentucky law with legislation to remove caps. Lorri Unumb stated that, in
2010, that 1 in 100 children were diagnosed with autism, and data indicates that
1 in 88 children are diagnosed in 2013.

Ms. Metzger stated that Anthem is committed to working with
providers. When House Bill 159 passed, Anthem put together a work group of 100
associates to deal with the changes. Coding is a problem, and the company has contacted
families regarding claims that need to be resubmitted to receive reimbursement.

Kelli Rodman stated that Humana has experienced the same
issues as Anthem and has worked with members to process claims. Humana is
committed to working with interested parties to make the filing and
reimbursement process easier.

Representative Greer stated that willingness to cooperate is
what he has wanted to hear from all parties.

Senator Buford stated that he feels it is hard to discuss
such matters on the phone and that maybe the interested parties should meet,
discuss codes for autism disorders, and possibly visit Highlands Center for
Autism.

Representative Greer and Senator Buford asked that the
parties update the committee on their meetings and any progress.